Anxiety Disorders. Phenomenology. Phenomenology. Dr. Boland: Anxiety Disorders. Mental Status Exam. General appearance Physical symptoms of anxiety

Transcription

1 Anxiety Disorders Phenomenology Phenomenology Mental Status Exam General appearance Physical symptoms of anxiety Emotional symptoms Thoughts Cognitive symptoms 1

2 Phenomenology Anxiety as Warning Signal What really sets it off? Focus: Panic Disorder Epidemiology Overall Anxiety: Most prevalent of psychiatric disorders. Panic: 1.5 to 3.5% Onset: mid 20 s Gender 2

3 Pathology/Physiology Focuses of research Precipitators of panic lactic acid, infusion, carbon dioxide inhalation Neurotransmitters Catecholamines GABA Genetics Identical twins 45%:15% mono:di (versus 2% control) Psychological Theories Ex. Learning theory (conditioning) 3

4 DSM-IV Diagnosis Syndrome versus Diagnosis Panic Attacks, Agoraphobia Panic Disorder DSM Syndromes Panic Attacks multiple symptoms (4 or more): starts abruptly, peaks in about 10 minutes Panic Heart stuff Sweat Trembling SOB, smothering Choking sensation Chest pain nausea Dizziness Derealization or depersonalization Fear of losing control/crazy Fear of dying Paresthesias chills 4

5 Sudden +/- precipitant Peak: minutes Last 5-30 minutes Anticipatory/persistence Panic Attacks DSM Syndromes Agoraphobia fear/avoidance of places/situations. fear panic attack. DSM Diagnosis Panic Disorder, with and without Agoraphobia recurrent Panic Attacks anticipatory anxiety "Global Criteria". Can be with or without Agoraphobia. 5

6 Differential Diagnosis Other medical disorders endocrine cardiopulmonary disorders neurologic disorders Differential Substance induced disorders withdrawal syndromes intoxication/therapeutic syndromes Differential Other psychiatric syndromes mood disorders psychotic disorders Personality Adjustment disorders 6

7 Comorbid Disorders Mood disorder--depression Medical disorders mitral valve prolapse and panic. Ulcers HTN Suicide Course and Prognosis Onset: late teens-early adult? bimodal Course: chronic, waxing and waning Outcome at 6-10 years follow-up: 1/3 well 1/2 «improved but symptomatic 1/5-1/3: same or worse Relapse: high risk Agoraphobia Other Diagnoses 7

8 Other Diagnoses All of The Disorders Panic Disorder (w/ or w/o Agoraphobia) Agoraphobia w/o Panic Specific Phobia Social Phobia Obsessive-Compulsive Disorder Posttraumatic Stress Disorder Acute Stress Disorder Generalized Anxiety Disorder Anxiety Disorder Due to a General Medical Condition Substance-Induced Anxiety Disorder Agoraphobia without History of Panic Disorder Agoraphobia No panic disorder Not due to a medical/substance disorder Specific Phobia XS fear of object/situation avoidance/anxious endurance of object/situation "Global Criteria" Specific Types» Animal Type» Natural Environment Type (heights, storms, water)» Blood-Injection-Injury Type» Situational Type» Other. 8

9 Social Phobia XS fear of a social situation (humiliation) Global Criteria Typical: talking, eating, bathroom stuff can be generalized. Diff: agoraphobia Obsessive-Compulsive Disorder (OCD) either or both: obsessions compulsions Good insight Global Criteria". Posttraumatic Stress Disorder (PTSD) After trauma: 3 types of symptoms re-experiencing trauma Avoidance/numbing Arousal Global Criteria. Timing Acute (< 3 months) versus chronic. requires more than 1 month of symptoms 9

10 Acute Stress Disorder Like PTSD, but less than 1 month. Generalized Anxiety Disorder (GAD) "Always anxious." Excessive worry 6 months. Associated with ( 3) restlessness fatigueability difficulty concentrating irritability muscle tension insomnia 10

11 Anxiety Disorder Due to a General Medical Condition, and Substance-Induced Anxiety Disorder can be GAD-like panic attacks OCD symptoms. phobic symptoms 11